ROBOTIC MANIPULATOR FOR GUIDING AN ENDOSCOPE WITH PARALLEL KINEMATICS

Description

[0001] The invention relates to a surgical manipulator device for positioning a surgical instrument, in particular an endoscope.

[0002] Surgical manipulator devices are generally known and are used in surgery, in particular attached to a stand or holding arm, to hold certain surgical instruments during an operation or other examination.

[0003] Such a surgical manipulator device is known, for example, from EP 1 658 016 B1 and from WO 01 / 34017 A2. The device disclosed therein is designed to hold an endoscope and is fundamentally motorless.The device comprises a frame with a linkage assembly comprising at least two links, which pivotally connects the frame to a first pivot point associated with the instrument, and with a second linkage assembly comprising at least two links, which pivotally connects the frame to a second pivot point associated with the first instrument, wherein the links of the first linkage assembly are pivotably mounted relative to each other and relative to the frame about pivot axes, and the pivot axes run parallel to each other, and wherein the two linkage assemblies are designed such that the first pivot point is movable in a first plane of motion and the second pivot point is movable in a second plane of motion, characterized in that the first plane of motion is movable relative to the second plane of motion. This is used in EP 1 658 016 to compensate for a changing distance between the first and second pivot points when pivoting at different angles.To compensate for movement of the first and second linkage assemblies. This is particularly necessary because the instrument is directly connected to the pivot points. A disadvantage of such a device is that attaching the frame to a stand is difficult, as the frame itself must also allow movement of the plane. Furthermore, the stability and rigidity of such a system are insufficient for some surgical applications.

[0004] The surgical manipulator device of the present invention is to be mounted in particular on a holding arm, as described in DE 10 2014 016 823 A1, DE 10 2014 016 824 A1, DE 10 2015 104 810 A1, DE 10 2015 104 819 A1 and EP 3 130 305 A1.

[0005] One object of the present invention is therefore to provide a surgical manipulator device of the type mentioned at the outset, which can be coupled to the holding arm disclosed in DE 10 2014 016 823 A1, DE 10 2014 016 824 A1, DE 10 2015 104 810 A1, DE 10 2015 104 819 A1 and EP 3 130 305 A1, wherein the surgical manipulator provides high rigidity, a small installation space, high positioning accuracy and as free a working and viewing field as possible for the surgeon.

[0006] This problem is solved in a surgical manipulator device of the type mentioned above according to claim 1 in that it comprises: a frame, a first holder and a second holder for holding an instrument receptacle for the surgical instrument, a first linkage mounted on the frame which pivotally connects the frame to the first holder, and a second linkage which pivotally connects the frame to the second holder, wherein the first and second linkages are each movable in first and second planes of motion parallel to and spaced apart from each other relative to the frame, such that the first holder is movable in the first plane of motion and the second holder is movable in the second plane of motion, wherein the first linkage is coupled to the frame at four lever pivot points of the first linkage, and the second linkage is coupled to the frame at four lever pivot points of the second linkage.In this arrangement, each lever pivot point of the first linkage assembly shares a common axis of rotation with a lever pivot point of the second linkage assembly. According to the invention, this creates a manipulator device that can move the first and second holders in separate planes of motion that are always parallel to each other. The present surgical manipulator device does not implement a pivoting of the planes relative to each other, as proposed in the prior art. This eliminates the need for a joint in the frame, allowing the frame to be designed with greater overall rigidity. Each linkage assembly is also coupled to the frame via four lever pivot points, which further increases rigidity. Two lever pivot points per linkage assembly are generally sufficient for simply positioning the first and second holders. The two additional points provided according to the invention then serve primarily for stabilization.

[0007] The following discloses a method for positioning a surgical instrument, a coupling element, and an instrument receiving device. However, these are not claimed and serve only to better understand the invention.

[0008] Preferably, the four first lever pivot points and the four second lever pivot points are each arranged in a V-shape. This further prevents the linkage assemblies from assuming singularities. The V-shaped arrangement of the four lever pivot points per linkage assembly ensures that each position of the first and second supports is unambiguous. Geometrically or statically indeterminate positions are avoided. This significantly increases the safety of the surgical manipulator device, as singularities in the kinematics cannot occur during an operation. While an arrangement of the four first lever pivot points and the four second lever pivot points in a rectangle is also generally preferred within the scope of the invention, other means should then be provided to exclude singularities, such as limiting the freedom of movement.

[0009] The angle of V is preferably in a range from greater than 0° up to and including 90°. Such angles have proven to be particularly advantageous. Smaller angles, for example 45° or less, 30° or less, or 20° or less, are also preferred. This allows for a more compact manipulator device.

[0010] According to a first preferred embodiment, the second linkage assembly is essentially mirror-symmetrical to the first linkage assembly. The first and second linkage assemblies are preferably mirror-symmetrical with respect to a plane perpendicular to the planes of motion. The second linkage assembly can be mirror-symmetrical to the first linkage assembly or identical to the first linkage assembly and offset by a distance. This reduces the number of parts and increases the number of identical parts. This, in particular, reduces manufacturing costs.

[0011] According to the invention, the four lever pivot points of the first linkage assembly and the four lever pivot points of the second linkage assembly are arranged on four common axes of rotation. That is, each pivot point of the first linkage assembly shares a common axis of rotation with a lever pivot point of the second linkage assembly. For example, the first lever pivot point shares a common axis of rotation with the fifth lever pivot point, the second lever pivot point shares a common axis of rotation with the sixth lever pivot point, the third lever pivot point shares a common axis of rotation with the seventh lever pivot point, and the fourth lever pivot point shares a common axis of rotation with the eighth lever pivot point. This further simplifies the design, and the linkage assemblies can be designed symmetrically. This particularly improves the freedom of movement and the working area of ​​the surgical manipulator device.

[0012] In one variation of this, the four lever pivot points of the first linkage assembly and the four lever pivot points of the second linkage assembly are not arranged on the same four axes of rotation. The axes of rotation are offset from each other. This shifts the initial position of the holders relative to one another, allowing for an initial angle of attack. This has the advantage of enabling an application-specific or patient-specific angle of attack for the surgical instrument held by the holders. This can, for example, improve instrument accessibility to a surgical site and / or allow for more efficient use of the manipulator's working space.

[0013] According to a further preferred embodiment, the first and second linkage assemblies are formed from exactly three different linkage elements. These three different elements are preferably levers, linkages, and rods. These three different elements will be explained in more detail below. The inventors have recognized that it is sufficient to use these three different elements to form the first and second linkage assemblies. This simplifies the design and allows for the use of identical parts. This also reduces costs.

[0014] Preferably, the first handlebar assembly comprises a first, a second, a third, and a fourth lever, each rotatably mounted on the frame at the first, second, third, and fourth lever pivot points of the first handlebar assembly. Furthermore, the first handlebar assembly comprises a first handlebar that is rotatably coupled to the first and second levers. It also comprises a second handlebar that is rotatably coupled to the third and fourth levers. Preferably, the axes of rotation of the first and second levers define a first leg of the V, and the axes of rotation of the third and fourth levers define a second leg of the V.

[0015] Furthermore, the first handlebar assembly is designed to have first and second bars that are rotatably connected to the first handlebar on one side and to the first bracket on the other. Similarly, the first handlebar assembly has third and fourth bars that are rotatably connected to the second handlebar on one side and to the first bracket on the other. Thus, the first bracket is connected to the frame via the first handlebar assembly.

[0016] The first and second bars are preferably arranged parallel to each other. The third and fourth bars are also preferably arranged parallel to each other.

[0017] Similarly, the second handlebar assembly has a fifth, a sixth, a seventh, and an eighth lever, each rotatably mounted to the frame at the fifth, sixth, seventh, and eighth lever pivot points of the second handlebar assembly, respectively. The second handlebar assembly also has a third handlebar rotatably coupled to the fifth and sixth levers and a fourth handlebar rotatably coupled to the seventh and eighth levers. Furthermore, the second handlebar assembly has fifth and sixth rods rotatably coupled to the third handlebar and the second bracket, respectively. Similarly, the second handlebar assembly has seventh and eighth rods rotatably coupled to the fourth handlebar and the second bracket, respectively.In this way, the second holder is coupled to the frame, as has already been described with reference to the first holder.

[0018] Preferably, the fifth and sixth bars are arranged parallel to each other. It is also preferred that the seventh and eighth bars are arranged parallel to each other.

[0019] According to a further preferred embodiment, the first linkage assembly comprises a first, a second, a third, and a fourth parallelogram. Preferably, the second linkage assembly also comprises a fifth, a sixth, a seventh, and an eighth parallelogram.

[0020] Preferably, the first parallelogram is formed by the first and second levers, the first handlebar, and the frame. The second parallelogram is preferably formed by the first and second rods, the first handlebar, and the first bracket.

[0021] Similarly, the third parallelogram is preferably formed by the third and fourth levers, the second link, and the frame. The fourth parallelogram is preferably formed by the third and fourth bars, the second link, and the first bracket. The third and fourth parallelograms are primarily intended for stabilization; the first and second parallelograms for positioning the first bracket. Similarly, the fifth parallelogram is preferably formed by the fifth and sixth levers, the third link, and the frame. The sixth parallelogram is preferably formed by the fifth and sixth bars, the third link, and the second bracket. The seventh parallelogram is preferably formed by the seventh and eighth levers, the fourth link, and the frame. Similarly, the eighth parallelogram is preferably formed by the seventh and eighth bars, the fourth link, and the second bracket.The sixth and eighth parallelograms also serve primarily for stabilization, while the fifth and seventh parallelograms serve for positioning.

[0022] By connecting the parallelograms in series, the first holder can only be moved in one plane, namely the first plane of movement, in the x and y directions. Similarly, the second holder can only be moved in the second plane of movement, also in the x and y directions.

[0023] It is further preferred that the first and second parallelograms share a common pivot point. Preferably, the third and fourth parallelograms also share a common pivot point. Likewise, the fifth and sixth, and the seventh and eighth, parallelograms each preferably share a common pivot point. This further simplifies the design and reduces the size of the surgical manipulator device. Since the parallelograms are connected in series, each linkage forms an element of two parallelograms, thus making it possible to implement common pivot points.

[0024] According to another preferred embodiment, the surgical manipulator device has a drive for the first and second linkage assemblies. This makes it possible to drive the linkage assemblies in order to position the first and second holders in the first and second planes of motion.

[0025] In a preferred embodiment, the drive comprises a first and a second motor for the first handlebar assembly and a third and a fourth motor for the second handlebar assembly. The first, second, third, and fourth motors are preferably operable independently of one another. They are preferably designed as electric motors with a rotating output shaft. Preferably, all four motors are identical in construction.

[0026] Preferably, the first and second motors drive the levers located distal to the first holder, and the third and fourth motors drive the levers located proximal to the second holder. That is, preferably the first motor drives the first lever, the second motor the third lever, the third motor the sixth lever, and the fourth motor the eighth lever. If the levers always share a rotational axis in pairs, an arrangement is achieved in which, of each pair of levers sharing a rotational axis, one lever is driven and the other is passive. This significantly reduces the size of the surgical manipulator device. The four drive motors can be arranged so that their rotational axes are parallel to each other. It is not necessary to arrange the individual motors approximately coaxially and axially offset from one another, since no two motors share a common rotational axis.

[0027] In a preferred embodiment, or additionally, the surgical manipulator device comprises a braking device for actively braking the first and second handlebar assemblies, as well as a release unit for selectively releasing one or more degrees of freedom of the first and / or second handlebar assemblies. The braking device preferably includes a first and a second brake for the first handlebar assembly, and a third and a fourth brake for the second handlebar assembly. Preferably, the first and second brakes brake the levers located distal to the first holder, and the third and fourth brakes brake the levers located proximal to the second holder. In this respect, the brakes are preferably arranged analogously to the described motors and can be used in place of the motors in the frame.This creates a passive surgical manipulator device whose braking device can be released manually, in particular by means of the release unit, in order to adjust the pose of the first and second control arm arrangements and the position of the first and second holders in the first and second planes of motion.

[0028] The brakes of the braking device are preferably engaged when de-energized. They are preferably designed as electromagnetic brakes. Energizing the brakes releases them, and the position of the first and second linkage assemblies is adjustable.

[0029] The release unit preferably comprises a switch or the like and is coupled to the braking system. The braking system may include a brake control unit that controls the brakes separately or together. The release unit is preferably designed such that each brake can be released and locked separately and / or all brakes can be released together. The release unit is preferably located remotely from the frame, the braking system, and / or the first and second linkage assemblies, in particular on a surgical instrument to be mounted, on a floor, or on an operating table, and is connected to the braking system by cable or wirelessly to provide a release signal. The release unit can, for example, be designed as a foot pedal.In another variant, the release unit has a switch and a base and can be clipped onto a surgical instrument held by the first and second guides. This allows the operator, upon grasping the surgical instrument, to activate the release unit, thereby releasing the brakes and manually adjusting the position of the first and second guide assemblies, and thus the position of the surgical instrument. This provides intuitive operation. Additionally or alternatively, the release unit is wirelessly connected to the braking system or a brake control unit of the braking system, for example, via Wi-Fi, Bluetooth, or a higher-order wireless transmission system. For instance, the release unit includes a software program that runs on a handheld computer, such as a mobile phone, tablet PC, or similar device.In another variant, the release unit is designed like a remote control and provides the release signal to the braking device via infrared radiation. The braking device is equipped with a corresponding receiver for this purpose. However, it is also conceivable that the release unit additionally or alternatively has a manually operated switch located on the housing of the surgical manipulator device.

[0030] In a further preferred embodiment, the surgical manipulator device has an instrument holding device that is pivotally coupled to the first and second holders. The instrument holding device preferably has positive locking means configured to receive a coupling element for the surgical instrument. According to the invention, the surgical instrument is preferably not directly coupled to the first and second holders, but rather an instrument holding device is coupled to the first and second holders, and the instrument can then be selectively connected to the instrument holding device. On the one hand, it is conceivable that the surgical instrument is connected directly to the instrument holding device; however, it is preferred that the instrument be connected to a coupling element, which is then itself positively locked to the instrument holding device.

[0031] The instrument holding device is preferably designed to allow for a changing distance between the first and second holders due to different positioning of the first and second holders in the first and second planes of motion. For example, it is conceivable that the instrument holding device is rigidly coupled to the first holder, while a sliding guide and / or slip clutch is provided on the second holder, and the instrument holding device is held in this sliding guide or by means of the slip clutch on the second holder. The sliding guide is preferably designed such that the instrument holding device is movable relative to the second holder.This allows for compensation of the changing distance between the first and second holders without pivoting the first and second planes of movement relative to each other and without requiring the first and second holders to leave their respective planes of movement. This prevents tension. Furthermore, it increases the torsional stiffness of the instrument holding device while simultaneously reducing stiffness in the direction of the instrument, which is advantageous for patient safety.

[0032] Preferably, the coupling element is made of an insulating material in order to electrically isolate an instrument from the instrument holding device if it is mounted within the coupling element. This significantly improves the safety of the surgical manipulator device.

[0033] In a further preferred embodiment, the instrument holding device has a linear drive for positioning the instrument at least partially perpendicular to the first and second planes of motion. This creates an additional degree of freedom for the surgical manipulator device, and the instrument can be moved, in particular, perpendicular to the planes of motion. This is especially advantageous when the instrument held is, for example, an endoscope, a catheter, or a biopsy needle—instruments that are essentially intended to be moved along their own longitudinal axis during an examination.

[0034] In a preferred embodiment, the linear drive comprises an elongated sleeve, a spindle drive arranged within the sleeve, and an output element that carries the positive locking means. The spindle drive drives a magnetic driver arranged within the sleeve, and the output element is mounted externally and linearly displaceably on the sleeve and coupled to the driver by magnetic force. This design allows the sleeve to be externally flat and free of through-holes, grooves, or other recesses, thus improving hygiene. The magnetic driver inside the sleeve is coupled to a spindle drive, which in turn drives the magnetic driver to move it linearly.A spindle drive generally offers the advantage of achieving high positioning accuracy without introducing excessively strong electromagnetic fields, as is the case, for example, with conventional electromagnetic linear drives. A small electric motor, which can be located at one end of the sleeve, is sufficient to drive the spindle. Due to the purely magnetic coupling between the output element and the magnetic driver, it is also possible to remove the instrument, along with the output element, from the instrument holder without completely disassembling the instrument holder.

[0035] According to a further preferred embodiment, the instrument holder has a rotary drive designed to rotate a mounted surgical instrument about an axis of rotation, the axis of rotation preferably being substantially parallel to a drive direction of the linear drive. This allows the surgical instrument to rotate about a further axis. Typically, a surgical instrument is mounted on the instrument holder in such a way that it can be driven linearly along its longitudinal axis, particularly with respect to an endoscope, which is movable along its shaft axis. For angled optics, it is preferred to implement the rotary drive of the present embodiment in order to enlarge the field of view.

[0036] According to a further preferred embodiment, the instrument holding device includes a force-torque sensor unit configured to detect forces and torques exerted on the instrument holding device by a surgical instrument held there. Preferably, the force-torque sensor unit is coupled to the control unit of the surgical manipulator device, and the control unit includes software means configured to process the signals provided by the force-torque sensor unit and to control a drive of the surgical manipulator unit and / or the linear drive of the instrument holding device, or another drive of the instrument holding device, accordingly. The force exerted by the instrument on the instrument holding device can represent an operator request.For example, an operator might manually grasp an instrument held in the instrument holder and guide it to a specific point. In this case, forces and moments act on the instrument holder from the instrument, which are then detected by the force-torque sensor unit. In this variant, the control system preferably includes determining a movement and / or pose for the first and second linkage assemblies and / or the linear actuator to counteract the forces and moments acting on the instrument holder; and controlling the actuator and / or the linear actuator in accordance with this movement or pose to execute or assume this movement and / or pose.

[0037] In the event that the force on the instrument is exerted by a patient instead of an operator—for example, due to user error, a suboptimal manipulator position, or patient movement—this procedure reduces the force and provides relief. Safety is improved.

[0038] Furthermore, it is preferred that the control unit receives signals from the force-torque sensor unit representing the weight of a mass attached to the instrument holder. This load weight causes a slight elastic deformation in the surgical manipulator device due to the finite stiffness of the system. In this embodiment, the control unit of the surgical manipulator device stores data representing the system stiffness. When determining the pose to achieve a desired position with the surgical instrument, the mass attached to the instrument holder is then preferably taken into account.To determine the pose, the following steps are preferably performed in this case: determining a deflection due to the mass taken up in the target pose of the first and second control arm assemblies; determining an adapted target pose based on the determined deflection; and moving the first and second holders by means of the first and second control arm assemblies into the adapted target pose to position the surgical instrument.

[0039] According to a further preferred embodiment, the surgical manipulator device comprises an electronic control unit with storage means and a processor for controlling the movement and positioning of at least the first and second holders. The electronic control unit is preferably also configured to control the linear drive of the instrument holding device or another drive of the instrument holding device.

[0040] Furthermore, it is preferred that the surgical manipulator device has an electronic interface for receiving control signals from a higher-level control unit, in particular an operating room navigation system or a surgical holding arm with the higher-level control unit. On the one hand, it is conceivable that the surgical manipulator device receives control signals directly via the electronic interface for the drive of the first and second linkage arrangements and / or the linear drive of the instrument holding device or another drive of the instrument holding device, and thus does not require its own intelligence.On the other hand, it is also conceivable that the surgical manipulator device has the electronic control unit with storage means and processor and is therefore autonomously able to determine control signals for the drive and / or the linear drive of the instrument holding device or another drive of the instrument holding device, in particular based on inputs from an operator or based on control signals received via the electronic interface.For example, it is conceivable that a desired target position of the surgical instrument is received via the electronic interface and the electronic control unit of the surgical manipulator device then determines corresponding control signals from this target position for the drive and / or the linear drive of the instrument holder or another drive of the instrument holder in order to control the drive and / or the linear drive of the instrument holder or another drive of the instrument holder accordingly, to cause the first and second linkage assemblies to move and position the first and second holders and / or to control the linear drive of the instrument holder or another drive of the instrument holder accordingly.The electronic interface can be configured as a wired interface with physical contacts or as a wireless interface that receives the control signals from the higher-level control unit. Wi-Fi, Bluetooth, infrared, or more advanced interfaces are particularly suitable for this purpose. A key advantage is that the surgical manipulator is coupled to a holding arm, as described above, and that the holding arm receives the control signals. In one embodiment, the holding arm can determine these control signals itself, or the holding arm can receive the control signals from a higher-level control system, such as an operating room navigation system, and then provide them to the surgical manipulator.

[0041] It is further preferred that the surgical manipulator device has an integrated input system for receiving user input. The integrated input system is preferably coupled to the control unit of the manipulator device, or the surgical manipulator device has a separate control unit for the integrated input system. In one embodiment, the integrated input system includes a microphone for receiving voice commands as user input. In this embodiment, the control unit to which the integrated input system is preferably connected preferably has at least one processor and software means suitable for processing voice commands and providing corresponding control signals to the drive of the first and second linkage assemblies, the linear drive of the instrument mounting device, another drive of the instrument mounting device, and / or the braking device.For example, upon receiving a "release" command, the control unit connected to the integrated input system may provide a corresponding release signal to the braking device. In another variant, user voice commands are simply recorded and stored so they can later be output in a surgical protocol. This makes it possible to assign specific surgical actions to particular user inputs based on the position of a surgical instrument.

[0042] It is further preferred that the integrated input system includes at least one camera that monitors the first and second guide assemblies, the position of the first and second holders, the position of a surgical instrument attached to the first and second holders, and / or the surgical field. Such a camera can, for example, detect which instruments are inserted into and removed from the surgical area. In this embodiment, the control unit preferably includes software designed to recognize instruments inserted into and removed from the surgical area using image recognition algorithms, to timestamp the corresponding signals, and to store and provide them for a surgical protocol.

[0043] According to a further preferred embodiment, the surgical manipulator device has a housing with a display device for indicating one or more states of the manipulator device. Such states may, in particular, include one or more of the following: movement of the first and / or second linkage assemblies, movement of a linear drive of an instrument holder, reception of signals, transmission of signals, reaching a target position of the first and second holders, reaching and / or exceeding a predefined working area of ​​the surgical manipulator device, direction in which the first and / or second holders are moved, or...to be moved, type of surgical instrument held, force acting on the surgical instrument, whether the surgical manipulator device is switched on, in standby mode, waiting for user input, and / or receiving a software update, reaching or approaching a home position of the first and second control arms, whether the first and second control arms are in or near an extreme position, the state of coupling with a holding arm, the state of a connection between a peripheral device and the electronic interface, the type of instrument held, in particular 0° endoscope, 30° endoscope, 45° endoscope, exoscope, switchable angle optics, or specific devices from third-party companies, the saving of an assumed pose of the first and second control arms in internal or external memory, the success of the saving, a graphical representation of the saved data (e.g.a reproduction of the stored pose), the establishment, use, and / or disconnection of a communication link between the surgical manipulator device and an external input system, in particular an operating room navigation system, whether a translational or rotational movement (swivel and / or tilt movement) of a captured instrument is performed, the distance between a captured instrument and a target position, a pre-stored pose of the first and second control arm arrangements selected from an internal memory and to be approached (e.g., a reproduction of the selected pose), the location of a pivot point of a captured surgical instrument, and a scaling level for a movement of a captured surgical instrument.

[0044] Preferably, the display device is designed to show the working area of ​​the manipulator. The display device shows the working area for swiveling and tilting movements, as well as for parallel movement of the instrument in the plane, on a top surface of the housing (relative to an initial position of the manipulator). The upper and lower working area boundaries of the instrument holder can also be displayed using a corresponding pattern, flashing frequency, color, and / or illumination intensity. Preferably, an upper display segment is illuminated for the upper working area boundary of the instrument holder, and a lower display segment for the lower working area boundary, both located on a lower surface of the housing (relative to the initial position). The user can then easily see whether and how much working area is available.

[0045] Preferably, the display device is configured to show how the working area of ​​the surgical manipulator device is oriented relative to its own origin coordinate system. For example, with the surgical manipulator device in the same orientation relative to a patient, the working area must be rotated so that a picked-up surgical instrument is logically and anatomically correctly positioned relative to the patient. An angled instrument adapter with a corresponding angle correction can be used for this purpose. By displaying the coordinate transformation, the operator is always informed about the orientation.

[0046] Preferably, the display device has at least two, and preferably at least four, display segments, each display segment being assigned to a pair or a single one of the four lever pivot points of the first and / or second linkage assembly. For example, a first display segment is assigned to the first and second lever pivot points of the first and second levers, and a second display segment is assigned to the third and fourth lever pivot points of the third and fourth levers. This allows the display device to indicate, for example, that the first and second levers are moving while the third and fourth levers are stationary. If the display device has four display segments, it can also be used to indicate the movement of the fifth through eighth levers.The third segment can then be used to indicate movement of the fifth and sixth levers, while the fourth display segment indicates movement of the seventh and eighth levers. This ensures the operator is always informed whether the first and second control lever assemblies are moving, and if so, in which direction or which segment of the assemblies is moving. The operator can thus see whether the instrument is moving and in which direction.

[0047] Preferably, the display device has one or more ring-shaped displays. Preferably, it encircles the four lever pivot points. This allows for easy visual assignment of the display device, and in particular individual display segments of the display device, to the lever pivot points, thus enabling intuitive operation by the user. It is also conceivable that a separate ring-shaped display is provided for each lever pivot point, coaxial to the pivot axis.

[0048] Furthermore, it is preferred that the display device is configured to indicate a movement of at least one part of the first and second linkage arrangements about a corresponding lever pivot point.

[0049] Furthermore, a method for positioning a surgical instrument, in particular an endoscope, by means of a surgical manipulator device, in particular according to one of the preferred embodiments of a surgical manipulator device described above according to the first aspect of the invention, is disclosed, comprising the steps of: determining a first vector for a first holder for holding an instrument receptacle for the surgical instrument, which lies within a first plane of motion; determining a second vector for a second holder for holding the instrument receptacle for the surgical instrument, which lies within a second plane of motion; moving the first holder in accordance with the first vector by means of a first linkage arrangement mounted on the frame, which pivotally connects the frame to the first holder;and moving the second holder in accordance with the second vector by means of a second linkage arrangement which pivotally connects the frame to the second holder, wherein the first and second planes of movement are always parallel to each other. It should be understood that the steps of the method can be carried out simultaneously or sequentially and their sequence need not necessarily correspond to that described. It should further be understood that the surgical manipulator device according to the first aspect of the invention and the method comprise the same and similar preferred developments. In this respect, full reference is made to the above description of the surgical manipulator device of the first aspect of the invention.

[0050] Preferably, the method also includes the steps of determining a speed and sequence at which the first and second holders are moved in accordance with the first and second vectors. Furthermore, the method preferably includes the steps of: determining a first rotation for the first holder; determining a second rotation for the second holder; rotating the first holder in accordance with the first rotation by means of the first linkage mounted on the frame; and rotating the second holder in accordance with the second rotation by means of the second linkage; wherein the axes of rotation of the rotations are arranged perpendicular to the first and second planes of motion. It should be understood that the axes of rotation of the first and second holders are perpendicular to the planes of motion.The axis of rotation of an instrument holder mounted on the holders need not necessarily be perpendicular to the planes of motion; it can also be inclined. Preferably, the movement in accordance with the first and second vectors, as well as the rotation in accordance with the first and second rotations, is automated, in particular by means of an electric drive provided in the surgical manipulator device.

[0051] It is further preferred that the method comprises the following steps: picking up a first surgical instrument at the instrument holder; and determining a pivot point of the first surgical instrument relative to an object by moving the first and second holders to the pivot point and storing this position in a memory. The first surgical instrument may in this case also be a pivot point gauge designed for determining the pivot point or a tactile instrument. A pivot point is generally understood to be a point on the surgical instrument that is essentially fixed relative to an object, such as the patient, or changes depending on the object, and around which the instrument must be rotated during an examination or operation.For example, in ENT surgery, the endoscope must be rotated around a specific pivot point, which is located particularly in the entrance area of ​​the nasal vestibule, essentially independent of the penetration depth of the endoscope into the nasal cavity.

[0052] This pivot point is preferably stored in a memory. Preferably, instructions describing a change in the pivot point, for example, depending on the penetration depth of the surgical instrument into the patient's body, are also stored. The memory can be located within the surgical manipulator device or remotely. By storing the pivot point, it can be used in subsequent operations or for determining movement paths, trajectories, and the like. By approaching the pivot point using the instrument or by positioning the first and second guides, the position of the first and second guide assemblies is known, along with the pivot point. Approaching a pivot point can be done manually, with a surgeon guiding the instrument to this point, in which case the first and second guide assemblies operate passively.Another possibility is a manually controlled approach, in which an operator guides the instrument, for example using a joystick or other control unit, to bring the instrument to the pivot point.

[0053] According to a further preferred embodiment of the method, the determination of the first and second vectors is performed using the stored pivot point. Preferably, the surgical manipulator can be switched between a pivot point mode and a normal mode. In pivot point mode, all movement paths and trajectories, in particular the first and second vectors and the sequential movement of the first and second linkage assemblies, are executed in accordance with the first and second vectors, taking the pivot point into account. That is, even when the instrument is pivoted or moved in any other way, it is always moved around the pivot point. In normal mode, however, the pivot point is not taken into account. The instrument can, for example, also be moved outside the pivot point.In this mode, for example, it is conceivable to move the first and second control arm assemblies with relative movements in a 1:1 ratio. This means that the instrument holder is not pivoted in this case, but only moved linearly. Switching the surgical manipulator between pivot point mode and normal mode preferably occurs in response to a signal, which is triggered, for example, by a switch on the surgical manipulator device or a remotely located switch, such as a foot pedal, by an operator. It is also conceivable that this signal is transmitted from a higher-level control unit, such as an operating room navigation system, to the surgical manipulator device. This can be done via a wired or wireless connection.

[0054] In a further preferred embodiment of the method, this comprises the steps of: receiving a signal representing a request to move to the pivot point; and determining the first and second vectors such that a mounted instrument is positioned at the pivot point. Preferably, the pivot point is stored using a pivot point gauge. After the pivot point has been stored, this pivot point gauge is removed from the mount, and another surgical instrument, in this case an endoscope or the like, is mounted at the instrument mount. The signal representing a request to move to the pivot point is then used to move the endoscope tip back to the pivot point. Such a request signal can be triggered, for example, by a switch or by another external signal.The first and second vectors are determined by positioning the instrument with its tip at the pivot point. This may also involve considering an axial extension at least partially perpendicular to the first and second planes of motion. In this case, approaching the pivot point preferably also includes actuating a linear drive of an instrument holding device.

[0055] According to another aspect of the method, this includes the step of determining a transformation matrix between a base of the surgical manipulator device and the pivot point. In addition to the coordinates of the pivot point, a transformation matrix is ​​preferably determined that then contains not only the point coordinates but also the current orientation of the surgical instrument, thus enabling the representation of a coordinate system at the pivot point. This is particularly advantageous for visualizations or further spatial transformations relative to the pivot point. The pivot point coordinates or the transformation matrices are preferably defined relative to a base coordinate system, which is defined by the surgical manipulator device or, more preferably, by a holding device, such as a holding arm or a stand, to which the surgical manipulator device is attached.Such a basic coordinate system is preferably based on an operating table.

[0056] Preferably, the coordinates of the pivot point and / or the transformation matrix are provided via an interface, for example via a RESTful API interface.

[0057] In a further embodiment of the method, the surgical instrument is preferably designed as a tactile instrument, and the method comprises the steps of: probing a first anatomical landmark of a patient using the tactile instrument; storing first landmark data representing the pose of the first and second control assemblies and / or the position of the first and second supports; and linking the first landmark data with first image data representing at least one pre-acquired tomographic image of the patient. Such pre-acquired or preoperatively acquired tomographic images are typically generated by the patient during surgery. These tomographic images can, for example, be acquired by a CT scanner.The method preferably further comprises the steps of probing a second anatomical landmark of the patient using the tactile instrument; storing second landmark data representing the pose of the first and second guide assemblies and / or the position of the first and second holders at the second anatomical landmark of the patient; and linking the second landmark data with second image data representing at least one previously acquired tomographic image of the patient. The same procedure can be applied to third, fourth, and fifth anatomical landmarks or further landmarks. In this way, subsequent intraoperative collisions between the surgical instrument and surrounding tissue can be avoided, and a planned movement path or trajectory can be implemented accordingly.

[0058] Furthermore, a coupling element for a surgical manipulator device is disclosed, in particular a surgical manipulator device according to one of the above-described preferred embodiments of a surgical manipulator device according to the first aspect of the invention, wherein the coupling element allows the coupling of a surgical instrument to an instrument receiving device, wherein the coupling element has a main body made of a flexible electrically insulating material, wherein the main body has positive locking means for coupling with the instrument receiving device and a clamping section for clamping coupling with the surgical instrument.

[0059] Furthermore, an instrument receiving device for a surgical manipulator device, in particular according to one of the above-described preferred embodiments of a surgical manipulator device according to the first aspect of the invention and for receiving a surgical instrument, is disclosed, wherein the instrument receiving device has a linear drive for positioning the instrument, wherein the linear drive has an elongated sleeve, a spindle drive arranged in the sleeve and an output element which carries the positive locking means, wherein the spindle drive drives a magnetic driver arranged in the sleeve and the output element is mounted externally and linearly displaceably on the sleeve and is coupled to the magnetic driver by means of a magnetic force.

[0060] The invention is explained in more detail below using an exemplary embodiment with reference to the accompanying figures. These figures show: Fig. 1 a perspective view of a robotic holding arm with a surgical manipulator device according to the invention; Fig. 2 a perspective view of the surgical manipulator device; Fig. 3 a side view of the surgical manipulator device according to the invention. Fig. 2 Fig. 4 shows a top view of the surgical manipulator device according to Fig. 3 , but without surgical instrument; Fig. 5 a bottom view of the surgical manipulator device according to Fig. 4 ; Fig. 6 the surgical manipulator device according to Fig. 4 in a second pose; Fig. 7 the surgical manipulator device according to Fig. 4 in a third pose; Fig. 8 the surgical manipulator device according to Fig. 4 in a fourth pose; Fig. 9 the surgical manipulator device according to Fig. 4in a fifth pose; Fig. 10 an enlarged view of the kinematics of the surgical manipulator device; Fig. 11 an enlarged view of a lever; Fig. 12 an enlarged view of a linkage; Fig. 13 an enlarged view of a rod; Fig. 14 an enlarged view of a holder; Fig. 15 an enlarged view of a gimbal element; Fig. 16 a side view of the surgical manipulator device without housing and with drive; Fig. 17 a side view of the surgical manipulator device without housing with brakes for the kinematics; Fig. 18 a side view of an instrument holding device; Fig. 19 a full section through the instrument holding device made of Fig. 18 Fig. 20: A first view of a coupling element including adapter; Fig. 21: A second view of the coupling element made of Fig. 20Fig. 22 a schematic representation of the manipulator device with peripherals; Fig. 23 a perspective view of the surgical manipulator device with a pivot point gauge; Fig. 24 a schematic representation of the pivot point control; Fig. 25 a schematic representation of a rotation of the surgical instrument around the pivot point; and Fig. 26 a perspective view of a housing of the surgical manipulator device with display device;

[0061] According to Figure 1 A holding device 1, shown in the form of a robotic holding arm, is mounted on which a surgical manipulator device 100 is mounted. The holding device has a proximal end 2 for attaching the holding device 1 to a base (not shown). According to this embodiment, the base can be designed as a standard rail of an operating table (the operating table is in Figure 1(not shown). Therefore, the holding device 1 has a clamping claw 3 at its proximal end 2, which can be manually tightened by means of a screw 3a. The holding device 1 also has a distal end 4 for receiving an attachment, which here is designed as a surgical manipulator device 100 according to the invention.

[0062] The holding device according to Figure 1The device has seven arm segments 10, 12, 14, 16, 18, 20, 22, with joints 11, 13, 15, 17, 19, 21, 23 provided between the individual arm segments 10 to 22. The first arm segment 10 forms the proximal end 2 and has the clamping claw 3. The arm segment 10 also has a power button 26 for switching on the entire holding device, two terminals for supplying the holding device with power and data, such as control signals and the like, and for transmitting data from the holding device to external units, such as operating room systems, as well as an emergency stop switch.

[0063] Joints 11, 15, 19 and 23 are designed as rotary joints and joints 13, 17 and 21 as pivot joints.

[0064] The holding device 1 has a display unit 32, 34, 36, 38, 40, 42, 44 at each joint 11, 13, 15, 17, 19, 21, 23, which are intended to display a status of the holding device 1.

[0065] The display units 32, 34, 36, 38, 40, 42, 44 are designed as essentially ring-shaped light sources, in particular as LED rings, according to this embodiment. The central axis of each ring runs essentially coaxially with the respective axis of rotation of the joint 11, 13, 15, 17, 19, 21, 23. While a single LED ring is provided for each of the joints 11, 15, 19, 23, two LED rings are provided for each of the joints 13, 17, and 21. The two LED rings are located at the front and rear joint sections 17', 17" (in Figure 1 (only provided with reference numbers, for example). This ensures that each display unit is always identifiable in any position of the holding device.

[0066] According to this embodiment, the holding device further comprises an operating device 50. The holding arm can be moved into a desired position by means of the operating device 50, which is configured to release the associated joint 11, 13, 15, 17, 19, 21, 23 upon contact between an operator and one of the seven arm segments 10, 12, 14, 16, 18, 20, 22. For this purpose, the operating device 50, according to this embodiment, has five contact sections 52, 53, 54, 55, 56, each contact section 52, 53, 54, 55, 56 being arranged on a different arm segment 11, 14, 16, 20, 22. The individual contact sections are designed as touch-sensitive surfaces or buttons, so that when an operator makes contact with a corresponding contact section, one or more associated joints are released.

[0067] The assignment of the individual joints 11, 13, 15, 17, 19, 21, 23 is regulated according to this embodiment as follows: Upon contact between an operator and the arm segment 10, i.e., the contact section 52, joint 11 is released. An operator can now influence one degree of freedom. If an operator comes into contact with the arm segment 14, joint 15 is released; upon contact with the contact means 54, joint 13 is released; upon contact with the contact means 55, joints 19 and 17 are released; and upon contact with the contact means 56, joints 23 and 21 are released. It is preferably provided that the corresponding display units 32, 34, 36, 40, 42, 44 indicate this release, in particular by illuminating the LED ring.

[0068] The exact design and function of the holding device are described in detail in DE 10 2014 016 823 A1, DE 10 2014 016 824 A1, DE 10 2015 104 810 A1, DE 10 2015 104 819 A1 and EP 3 130 305 A1. The disclosure content of these documents regarding the holding device 1 is fully incorporated herein by reference.

[0069] In this embodiment, the surgical manipulator device 100 holds an endoscope as a surgical instrument 102. The surgical manipulator device 100 has a housing 104 which has an interface 106 (see figure). Fig. 23 ), via which the surgical manipulator device 100 is coupled to the distal end 4 of the holding device 1. The interface 106 is referred to below with reference to Fig. 23 This will be explained in more detail.

[0070] The surgical manipulator device 100 (hereinafter also referred to as "manipulator device 100") also has a frame 108 (see Figure 108). Fig. 16 and 17 ), which defines a structure of the manipulator device 100. The frame is in Fig. 2 It is not visible because it is surrounded by housing 104.

[0071] A first linkage assembly 110 and a second linkage assembly 112 are mounted on the frame 108. The first linkage assembly 110 is movable in a first plane of motion B1, and the second linkage assembly 112 in a second plane of motion B2 (see also Fig. 3 The planes of motion B1 and B2 are parallel to each other and cannot be tilted relative to each other.

[0072] The first linkage assembly 110 connects the frame 108 to a first bracket 114, and the second linkage assembly 112 connects the frame to a second bracket 116. In this embodiment, the brackets 114 and 116 are used to ( Fig. 2and 3 ) an instrument receiving device 120 is attached, as detailed with reference to Figs. 18 and 19 will be explained in more detail.

[0073] There may also be embodiments in which an instrument is directly connected to the first and second linkage assemblies 110, 112, without the interposition of an instrument holding device 120. In particular, it is also conceivable that a surgical instrument 102 is integrally formed with the first and second holders 114, 116, especially in a material-bonded manner and not detachable from them without damage. In such a case, it may be preferable to provide a clip connection or the like between the first and second holders 114, 116 and the corresponding first and second linkage assemblies 110, 112, in order to be able to replace the surgical instrument 102 of the surgical manipulator device 100.

[0074] The first handlebar assembly 110 is coupled to the frame 108 at four lever pivot points 121, 122, 123, 124 of the first handlebar assembly 110, and the second handlebar assembly 112 is coupled to the frame 108 at four lever pivot points 125, 126, 127, 128 of the second handlebar assembly (see also Fig. 4, 5 ).

[0075] The first lever pivot point 121 has a first axis of rotation R1, the second lever pivot point 122 a second axis of rotation R2, the third lever pivot point 123 a third axis of rotation R3, and the fourth lever pivot point 124 a fourth axis of rotation R4. The four lever pivot points 125, 126, 127, 128 of the second linkage arrangement 112 are designated as the fifth lever pivot point 125, sixth lever pivot point 126, seventh lever pivot point 127, and eighth lever pivot point 128. In this embodiment (see Figure 1), the lever pivot point 121 has a first axis of rotation R1, the second lever pivot point 122 has a second axis of rotation R2, the third lever pivot point 123 has a third axis of rotation R3, and the fourth lever pivot point 124 has a fourth axis of rotation R4. Fig. 3 , 4 and 5The four lever pivot points 121, 122, 123, 124 of the first linkage assembly 110 share common axes of rotation R1, R2, R3, R4 with the four second lever pivot points 125, 126, 127, 128 of the second linkage assembly 112. Therefore, the fifth lever pivot point 125 has the axis of rotation R1, the sixth lever pivot point 126 the axis of rotation R2, the seventh lever pivot point 127 the axis of rotation R3, and the eighth lever pivot point 128 the axis of rotation R4.

[0076] The first and second linkage arrangements 110, 112 are identical in this embodiment, but mirror-symmetrical, as can be seen in particular from the Fig. 3 , 4 and 5 can be seen in the bottom view ( Fig. 5 The second handlebar assembly 112 appears identical to the first handlebar assembly 110 in the top view according to the Fig. 4 .

[0077] The first linkage arrangement 110 has first and second arm segments 80, 82, which are themselves identical and mirror-symmetrical (cf. Fig. 4 The second linkage arrangement 112 has corresponding first and second arm segments 84, 86, which in turn are identical in themselves but mirror-symmetrical.

[0078] Each of the arm segments 80, 82, 84, 86 comprises two parallelograms, namely a first parallelogram 91, a second parallelogram 92, a third parallelogram 93 and a fourth parallelogram 94. The second lever joint arrangement 112 has a fifth parallelogram 95, a sixth parallelogram 96, a seventh parallelogram 97 and an eighth parallelogram 98.

[0079] The first linkage assembly 110 comprises a first lever 131, a second lever 132, a third lever 133, and a fourth lever 134, whose axes of rotation are the axes of rotation R1, R2, R3, and R4, respectively. Similarly, the second linkage assembly 112 comprises a fifth lever 135, a sixth lever 136, a seventh lever 137, and an eighth lever 138, whose axes of rotation are also the axes of rotation R1, R2, R3, and R4. It should be understood that there are also embodiments in which the axes of rotation of the levers 135, 136, 137, 138 and thus also the axes of rotation of the fifth, sixth, seventh and eighth lever pivot points 125, 126, 127, 128 are offset parallel to the axes of rotation R1, R2, R3, R4 and therefore have their own, separate four axes of rotation.In particular, it is conceivable that the lever pivot points 125, 126, 127, 128 are offset in the direction of the interface 106 in order to provide an initial angle of attack for the surgical instrument 102 (cf. . Fig. 3 to provide.

[0080] All levers 131 to 138 are connected on the output side, that is, at the end opposite the lever pivot points 121 to 128, to a link 141, 142, 143, 144. The first and second levers 131, 132 are connected on the output side to a first link 141, the third and fourth levers 133, 134 are connected on the output side to a second link 142, the fifth and sixth levers 135, 136 are connected on the output side to a third link 143, and the seventh and eighth levers 137, 138 are connected on the output side to a fourth link 144.

[0081] The first lever 131, the second lever 132, the first handlebar 141 and the frame 108 together form the first parallelogram 91. The third lever 133, the fourth lever 134, the second handlebar 142 and the frame 108 together form the third parallelogram 93. The fifth lever 135, the sixth lever 136, the third handlebar 143 and the frame 108 together form the fifth parallelogram, and the seventh lever 137, the eighth lever 138, the fourth handlebar 144 and the frame 108 together form the seventh parallelogram.

[0082] The first linkage assembly 110 further comprises a first rod 151, a second rod 152, a third rod 153, and a fourth rod 154. The second linkage assembly 112 comprises a fifth rod 155, a sixth rod 156, a seventh rod 157, and an eighth rod 158. The first and second rods 151, 152 pivotally connect the first linkage 141 to the first bracket 114, and the third and fourth rods 153, 154 pivotally connect the second linkage 142 to the first bracket 114. Similarly, the fifth rod 155 and the sixth rod 156 connect the third linkage 143 to the second bracket 116, and the seventh and eighth rods 157, 158 connect the fourth linkage 144 to the second bracket 116. This assembly is described again with reference to Fig. 10 will be explained in detail.

[0083] The first bracket 114 also accommodates a first gimbal element 146, and the second bracket 116 accommodates a second gimbal element 147. The instrument mounting device 120 is held by the gimbal elements 146 and 147, as will be described in detail later with reference to the Figure 17 and 19 The first and second cardan elements 146, 147 are rotatably mounted in corresponding joint sections 148, 149 of the first and second holders 114, 116.

[0084] The Figs. 6 to 9 Figure 1 illustrates four different positions of the first holder 114 in the top view, i.e., in plane B1. While in Fig. 6 The first bracket 114 is shifted into a left extreme position, the first bracket 114 is in Fig. 7 into a far-right position, in Fig. 8 into a forward extreme position and in Fig. 9shifted into a rearmost extreme position. A rotation about an axis perpendicular to the first plane of motion B1 is in the Figs. 6 to 9 not provided for and cannot be implemented due to the parallel kinematics used here.

[0085] The shift to the left side ( Fig. 6 (cf. arrow above the cardan element 146) is executed by rotating the first and second levers 131, 132 counterclockwise about the axes of rotation R1, R2, while the third and fourth levers 133, 134 are also rotated counterclockwise about the axes of rotation R3, R4. A corresponding rotation of the levers 131, 132, 133, 134 in the opposite direction displaces the first holder 114 to the right with respect to Fig. 7This is caused, as illustrated by the arrow above the gimbal element 146. If the levers 131, 132, 133, 134 are moved in opposite directions in pairs, that is, the first and second levers 131, 132 are rotated in opposite directions with respect to the third and fourth levers 133, 134, the first holder 114 is displaced within the first plane of motion B1 in an x-direction with respect to the coordinate system shown. This is also indicated by the arrow above the gimbal element 146 ( Fig. 8 ) or to the left of the cardan element 146 ( Fig. 9 ) displayed.

[0086] As can be seen from the Figs. 6 to 9As can be readily seen, the suspension of the first holder 114 with respect to the frame 108 is statically overdetermined. Only two levers, a linkage, and two rods would suffice for positioning the holder 114. For example, it is conceivable to use only the levers 132, 134 and the rods 152, 153 for positioning the holder 114. Likewise, it would be possible to use only the levers 131, 132, the linkage 141, and the rods 151, 152. However, by using these complex first and second linkage arrangements 110, 112 shown, a particularly high rigidity is achieved, and thus high positioning accuracy and repeatability.

[0087] In Fig. 10The first linkage assembly 110, including the first bracket 114 and the first cardan joint 146, is shown enlarged again to better illustrate the geometry. Also shown are the first, second, third, and fourth levers 131, 132, 133, 134, the first and second linkages 141, 142, and the first, second, third, and fourth rods 151, 152, 153, 154. Furthermore, the first bracket 114 and the first cardan joint 146 are shown. The first cardan joint 146 is coupled to the receptacle 148 and is rotatable about an axis K1 that lies within the first plane of motion B1. However, it can also be displaced parallel to this axis.

[0088] As especially from Fig. 10As can be seen, the levers 131, 132, 133, and 134 are all identical. The linkages 141, 142, 143, and 144 are also identical; linkage 142 is simply reversed relative to linkage 141, that is, rotated 180 degrees around an axis parallel to axis K1. The rods 151, 152, 153, and 154 are also identical, with rods 153 and 154 again rotated relative to rods 151 and 152. The same linkage elements are also used for the second linkage assembly 112. This is not shown, as the illustration would be identical to Figure 10, with only the reference numerals being changed.

[0089] In Fig. 10 The first, second, third and fourth parallelograms 91, 92, 93 and 94 are also shown by means of dashed lines.

[0090] Another detail that is in Fig. 10As can be seen, joints 160 to 169 of the first linkage assembly 110 are shown. The first lever 131 is articulated to the first bracket 141 via a first joint 160, and the second lever 132 is articulated to the first bracket via a second joint 161. Furthermore, the first rod 151 is articulated to the first linkage 141 via a third joint 162 and to the first bracket 141 via a fourth joint 163. The second rod 152 is articulated to the first bracket 114 via a fifth joint and, on the other side, also to the first linkage 141 by means of the second joint 161. The second joint 161 thus forms a common joint for the first and second parallelograms 91, 92. An angle β1 is provided between the first and second parallelograms 91, 92, which is defined by the geometry of the first link 141, more precisely by the arrangement of the first, second and third joints 160, 161, 162.It has been found that the angle β1 should be in a range of 90° to <180° to allow the use of identical parts, i.e. identical rods 151 to 158, identical levers 131 to 138 and identical linkages 141 to 144.

[0091] The same applies to the second arm segment 82 as to the first arm segment 80. The third lever 133 is connected to the second link 142 via a sixth joint, and the fourth lever 134 is connected to the second link 142 via a seventh joint 166. The third rod 153 is connected to the second link 142 via the seventh joint 167 and, on the other hand, to the first support 114 via a tenth joint 169. The fourth rod 154 is connected to the second link 142 via an eighth joint 167 and to the first support 114 via a ninth joint 168. Again, the third and fourth parallelograms 93, 94 form an angle β2, which corresponds to the angle β1.

[0092] As will be further shown Fig. 10As a result, the lever pivot points 121, 122, 123, 124 are arranged in a V-shape, and the rotation axes R1, R2, R3, R4 are also arranged in a V-shape. The V-shape is described by the two axes V1, V2, which are in Fig. 10 are shown as dashed lines. The angle α of the V lies in a range from >0° to 90°. The apex 150 of the V, i.e., the intersection of the axes V1 and V2, lies here in the first bracket 114 and thus in the working space of the kinematics. The V-shaped arrangement of the lever pivot points 121, 122, 123, 124, 125, 126, 127, 128 avoids singularities of the first and second link arrangements 110 and 112.

[0093] The Figs. 11 to 15 The three elements (lever, handlebar, and rod) of the handlebar assemblies 110 and 112, as well as the bracket and the cardan joint, are now shown separately. Only the first of these elements are shown as examples; the subsequent elements are always identical.

[0094] The handlebar 131 ( Fig. 11The assembly is manufactured from a single piece and comprises a circular body 170 with a drive section 171 and an output section 172. The lever 131 is pivotally connected to the frame via the drive section 171 and has three through-holes 173a, 173b, 173c for mounting screws. The three through-holes 173a, 173b, 173c are arranged circularly and equidistantly around the axis of rotation R1. A further through-hole 174 is formed on the output section 172, which serves to accommodate the first joint 160. An opening 175 is provided in the central section of the body 170, which is included for weight reduction purposes. The levers 132 to 138 are identical.

[0095] The driver 141 (see Fig. 12The body 176 has a base body 176. In the base body 176, a first through-opening 177 is formed for the first joint 160, a second through-opening 178 for the second joint 161, and a third through-opening 179 for the third joint 162. These through-openings 177, 178, and 179 are each designed to accommodate corresponding joint bushings for the joints 160, 161, and 162, respectively. The through-openings 177, 178, and 179 are arranged to enclose the angle β1, i.e., the angle β1 between the first and second parallelograms 91 and 92. The angle β1 can be changed by appropriately designing the first holder 141. The angle β1, for example, also has an influence on the geometry of the first holder 114, since the first holder 114 forms part of the second parallelogram 92.

[0096] Furthermore, the body 176 has two additional through-openings 180, 181, which are again included for weight reasons. Again, the second, third, and fourth linkages 142, 143, 144 are identical to the linkage 141.

[0097] The first staff 151 ( Fig. 13The rod 151 has a base body 182. Two end sections 183 and 184 extend at a slight angle, approximately 45 degrees, from the central section 185 of the rod 151. Through-openings 186 and 187 are provided in the end sections 183 and 184 to accommodate the third joint 162 and the fourth joint 163. Again, the through-openings 186 and 187 are designed to accommodate bearing bushings. An elongated through-opening 188 is provided in the central section 185, primarily for weight reduction. However, the through-opening 188 also offers an improved field of vision for the surgeon or operator when using the surgical manipulator device 100 according to the invention. The further rods 152 to 158 are identical to the first rod 151. The rod 151 is made entirely from a single piece and is milled from aluminum, for example.

[0098] The first holder 114 (cf. Fig. 14The holder 114 has a base body 189 and is manufactured in one piece. It has a first and a second arm 190, 191, the first arm 190 being designed for the first and second rods 151, 152 and the second arm 191 for the third and fourth rods 153, 154. For this purpose, a first and second through-hole 192, 193 are provided in the first arm 190, which serve to receive joint bushings and form a receptacle for the fourth and fifth joints 163, 164. A third through-hole 194 is provided between these first and second through-holes 192, 193 for weight reduction purposes. Similarly, the second arm 191 has a first and second through-hole 195, 196, which are designed to receive joint bushings and serve to accommodate the ninth and tenth joints 168, 169. Between these, a third through-hole 197 is provided, which is included for weight reduction purposes.The second holder 116 is formed identically.

[0099] The first cardan element 146 (cf. Fig. 15 ) is formed in one piece, for example from aluminum. It has a shaft 198 which can be received in the receptacle 148. A fork 199 extends from the shaft 198, which serves to receive the instrument receiving device 120. The fork 199 has (in Fig. 15 (Non-visible) openings 200a, 200b, along an axis K3 that is perpendicular to the axis K1. In this way, the instrument mounting device 120 can be mounted fully rotatably on the first and second holders 114, 116.

[0100] In one embodiment of the surgical manipulator device 100, it has a drive 210 ( Fig. 16 ). In Fig. 16The housing 104 and any circuit boards arranged within the housing 104 have been omitted to reveal the drive 210. In this embodiment, the drive 210 comprises four motors 211, 212, 213, and 214. Of these four motors 211, 212, 213, and 214, motors 212 and 214 are shown in Fig. 16concealed by motors 211 and 213. While the first and second motors 211 and 212 are intended for the first linkage 110, the third and fourth motors 213 and 214 are intended for the second linkage 112. The motors 211, 212, 213, and 214 are arranged with their axes of rotation on the axes of rotation R1, R2, R3, and R4. That is, the first motor 211 is coupled to the first lever 131, and the second motor 212 is coupled to the third lever 133. Similarly, the third motor 213 is coupled to the sixth lever 136, and the fourth motor 214 to the eighth lever 138. The first and second motors 211, 212 thus drive the levers 131, 133 arranged distal to the first holder 114, while the third and fourth motors 213, 214 drive the levers 136, 138 arranged proximal to the second holder 116.Preferably, a gearbox for torque and speed conversion is provided between the motors 211, 212, 213, 214 and the corresponding levers 131, 133, 136, 138. The motors 211, 212, 213, 214 are designed here as brushless DC motors.

[0101] Due to the special double-parallel kinematics of the first and second linkage assemblies 110, 112, it is sufficient to drive only two of the four levers in linkage assemblies 110, 112. This also allows the motors 211, 212, 213, 214 to be positioned adjacent to each other, parallel to one another, and not axially offset on a common axis of rotation. This significantly reduces the size of the surgical manipulator device 100, as is particularly evident from... Fig. 16 visible.

[0102] A control unit is provided for controlling motors 211, 212, 213, and 214, which receives signals via interface 106. This will be described in more detail below.

[0103] In Fig. 17A second embodiment of the manipulator device 100 is shown, which has no drive 210 but rather a braking device 220 for actively braking the first and second linkage assemblies 110, 112. The braking device 220 has four brakes 221, 222, 223, 224, which are attached to the frame 108 in a similar manner to the motors 211, 212, 213, 214. Again, the first brake 221 covers the second brake 222, and the third brake 223 covers the fourth brake 224. The brakes 221, 222, 223, 224 are each arranged coaxially with the axes of rotation R1, R2, R3, R4. The first brake 221 is coupled to the first lever 131, the second brake 222 to the third lever 133. Similarly, the third brake 223 is coupled to the sixth lever 136 and the fourth brake 224 to the eighth lever 138. Brakes 221 to 224 are designed as electromagnetic brakes, which are engaged when de-energized.

[0104] To release the braking device, the surgical manipulator device 100 has a release unit 225. By means of the release unit 225, one or more degrees of freedom of the first and / or second linkage assemblies 110, 112 can be released. In this embodiment ( Fig. 17 ) the release unit 225 is designed as a push button 226 and is also arranged on the frame 108 in such a way that it is accessible outside the housing 204 (see in particular Fig. 23By pressing this button 226, all brakes 221, 222, 223, 224 are released, and the first and second linkage assemblies 110, 112, and thus also the position of the first and second supports 114, 116, can be adjusted. In this way, a passive surgical manipulator device is formed, which can be easily moved into a desired position by an operator by pressing button 226 and manually adjusting it, and locked in place. To lock, simply release button 226. The brakes 221, 222, 223, 224 are then de-energized and tighten. The position of the first and second linkage assemblies 110, 112 is locked.

[0105] As mentioned above, an instrument mounting device 120 can be mounted on the first and second brackets 114, 116, optionally with the interposition of the first and second cardan elements 146, 147. The instrument mounting device, as shown in the Figures 18 and 19 The instrument holding device 120, as shown, is also disclosed independently of the manipulator device. It can also be used with other manipulators and not necessarily with the surgical manipulator device shown in the Figures 1 to 17 was explained.

[0106] The embodiment according to Figs. 18 and 19 The instrument mounting device 120 shown can not only be used as a rigid stand (although this is also preferred within the scope of the invention), but also has a linear drive 230. In detail, the instrument mounting device 120 first has a base housing 232, which has a recess 233 on its outside (with reference to Fig. 18 (a further recess is arranged on the opposite side of the foot housing 232), by means of which the foot housing 232 can be positively engaged but pivotably about the axis K3 in a cardan element 146, 147, in particular the lower cardan element 147 (see also Fig. 2 and 15 ). From the foot housing 232 extends in relation to Fig. 18 upwards, a sleeve 234, which is firmly connected to the base housing 232, extends along a longitudinal axis L1. The sleeve 234 has a substantially rectangular or square basic shape (see also Fig. 1 ) and is preferably made of a plastic or a non-magnetic material.

[0107] A second mounting point for the instrument mounting device 120 is formed by a slip clutch 235, which is slidably mounted along the longitudinal axis L1 on an outer side of the sleeve 234, as shown by the dashed lines of the slip clutch 235' in Fig. 18 As indicated, the slip clutch 235 also has two opposing recesses 236, as already described with reference to the base housing 232. The sleeve 235 is positively locked but rotatably connected to the first cardan element 146 via the recess 236 (cf. Fig. 2 The slip clutch 235 serves to compensate for a changing distance between the first recesses 233 and the second recesses 236 if the first and second linkage assemblies 110, 112 are not pivoted in unison. For example, it is conceivable that the first linkage assembly 110 moves into a position as shown in Fig. 6 shown is pivoted, and the second linkage 112 is moved into a position as shown in Fig. 7The longitudinal axis L1 is shown pivoting. In this case, the longitudinal axis L1 would not extend perpendicularly to the planes of motion B1, B2, but at an angle to them. In this case, the distance between the recesses 236, 233 would be increased compared to the situation when the longitudinal axis L1 is perpendicular to the planes of motion B1, B2. To compensate for this distance without introducing stresses or deformations into the first and second link assemblies 110, 112, the slip clutch 235 is slidably mounted.

[0108] The slip clutch 235 preferably has the tightest possible connection with the sleeve 234, without generating excessive friction. For this purpose, the slip clutch 235 can be provided with suitable materials on its inner surface.

[0109] In this embodiment, the linear drive 230 has a spindle drive 238 arranged in the sleeve 234. The spindle drive 238 comprises a spindle 239 that extends along the longitudinal axis L1 inside the sleeve 234. (With reference to...) Figure 19 The spindle 239 is mounted with a rotary bearing 241 at its upper axial end 240. (With reference to...) Figure 19 At its lower end 242, the spindle 239 is coupled to an electric motor 243, which drives the spindle 239 to rotate about the longitudinal axis L1. A corresponding control unit 245 for the electric motor 243 and an interface 246 for transmitting signals to the control unit 245 are arranged in an extension 244 of the base housing 232.

[0110] A magnetic driver 250 is arranged on the spindle 239 and engages with the external thread of the spindle 239 via an internal thread 251. The magnetic driver 250 can be moved along its longitudinal axis L1 by rotating the spindle 239. The magnetic driver 250 has a plurality of permanent magnets 252 on its radially outer side. The linear drive 230 also has an output element 254 in the form of a bushing, which is slidably arranged on the outside of the sleeve 234 along its longitudinal axis. On its inner side, the output element 254 carries a further number of permanent magnets 255, which correspond to the permanent magnets 252. In this way, the output element 254 is coupled to the magnetic driver 250 and can thus be moved back and forth along its longitudinal axis L1 by rotating the spindle 239.In this way, the sleeve 234 can be completely closed and does not require any indentations or projections on the outside, thereby significantly improving the hygiene of the surgical manipulator device 100 of the present invention.

[0111] The output element 254 further comprises a first coupling element 256, which in this case is designed as a hook-shaped retaining finger. The first coupling element 256 is connected to the bushing body of the output element 254 via a screw connection 257. The first coupling element 256 is preferably made of an insulating plastic that insulates a surgical instrument received via positive locking means 258 from the linear drive 230 and preferably from the bushing body of the output element 254.

[0112] If the instrument holding device 120 has a force-torque sensor unit 260, its attachment to the first coupling element 256 is preferred. All forces acting on the surgical manipulator device 100 from a surgical instrument 102 are transmitted via the first coupling element 256. The force-torque sensor unit 260 can, for example, have a force-torque sensor arranged between the screw connection 257. It is also conceivable that individual force sensors, such as strain gauges, are arranged directly on a surface of the first coupling element 256. The force-torque sensor unit 260 is preferably connected to the control unit 245 and / or provides signals via the interface 246.

[0113] The first coupling element 256 is shown in perspective in Figure 20 shown again. In the Figure 20In the illustration shown, the first coupling element 256 carries a second coupling element 262, which is intended for clamping a surgical instrument.

[0114] The coupling element 262 has a main body 264 made of a flexible, electrically insulating material, which includes positive locking means 266 for coupling with the positive locking means 258 of the instrument receiving device 120. Opposite the positive locking means 266, the main body 264 forms a clamping section 268. The clamping section 268 has a first and a second clamping jaw 269, 270, which are mirror images of each other. The clamping jaws 269 enclose a central axis K4 in a semicircular shape. The semicircular section of the clamping jaws 269, 270 corresponds approximately to three-quarters of a circle. At the end of the circular section 271, the clamping jaws 269, 270 each have a tab 272, 273, which have the same axial length as the clamping jaws 269, 270. The tabs 272, 273 widen by extending away from each other starting from the axis K4.The planes formed by the tabs 272, 273 preferably intersect at the central axis K4. The tabs 272, 273, due to their chamfered shape, facilitate the easy insertion of the instrument into the space between the clamping jaws 269, 270, and also the easy removal of the instrument 102 by manually grasping the tabs 272, 273 with the hands and spreading the clamping jaws 269, 270.

[0115] The clamping jaws 269, 270 provide a form-fitting fixation of the surgical instrument 102 in directions perpendicular to the central axis K4, but allow the surgical instrument 102 to be moved in the direction of the central axis K4, as is the case, for example, in Figure 2 can be seen.

[0116] In the area of ​​the positive locking means 266, the coupling element 262 further comprises a clipping device 274 with a locking finger and a locking lug that can engage in a corresponding recess on the first coupling element 262. The locking lug can be lifted out of the corresponding locking groove on the first coupling element 256 by means of the handle 275, thus releasing the positive locking connection between the second coupling element 262 and the first coupling element 256. The positive locking means 266, 258 can, for example, be designed as a dovetail guide or the like.

[0117] In the schematic representation ( Fig. 22 The surgical manipulator device 100 is shown with further peripheral devices. The surgical manipulator device 100 in turn has the first and second control arm assemblies 110, 112, which are shown in the Figure 22are simplified representations. In a first variant, the manipulator device 100 has a drive 210 and corresponding first, second, third, and fourth motors 211, 212, 213, and 214. In a second variant, also in Figure 22 In the variant shown, the manipulator device 100 has a braking device 220 with corresponding first, second, third and fourth brakes 221, 222, 223, 224. Since the schematic construction concerning the drive 210 and the braking device 210 does not differ, these can be shown in other figures.

[0118] Figure 22This is intended to illustrate, in particular, the electronic control unit 280. The electronic control unit 280 has storage means 282 and a processor 284 for controlling the movement and positioning of the first and second holders 114, 116. The electronic control unit 280 is connected via a line 286 to the interface 106, which is designed as a mechatronic interface. The surgical manipulator device is connected via this interface 106 to a higher-level control unit 290. This higher-level control unit 290 can be an operating room navigation system or the surgical holding arm 1. The connection between the higher-level control unit 290 and the manipulator device 100 can be physical, via a line or a contact 292 at the electronic interface 106, or wireless via a radio link 394.For example, the higher-level control unit 290 and the manipulator device 100 can communicate using infrared radiation, and the mechatronic interface 106 is equipped with a corresponding receiver in this case.

[0119] The control unit 280 of the manipulator device 100 can, for example, directly receive control signals S1 for the drive 210 and / or the braking device 220 from the higher-level control unit 290. For these embodiments, the control unit 280 does not require any special intelligence, but merely needs to provide the corresponding control signals to the motors 211, 212, 213, 214, or the brakes 221, 222, 223, 224. However, it can also be provided that the higher-level control unit 290 provides position request signals S2, that is, for example, a position at which a tool center point, or the tip of the surgical instrument 102, or a pivot point PT1, PT2 of the surgical instrument 102 should be located. In this case, data representing the first and second linkage assemblies 110, 112, respectively, are stored in the memory devices 282.the complete kinematics from the higher-level coordinate system, for example the coordinate system of a navigation system, to the corresponding Tool Center Point TCP or Pivot Point PT1, PT2.

[0120] Furthermore, the memory unit 282 contains software resources which, when executed by the processor 284, perform the following steps: determining a first vector and / or trajectory for a first holder 214, determining a second vector and / or a second trajectory for the second holder 216, and providing control signals to the motors 111, 112, 113, and 114 to move the first holder 14 in accordance with the first vector or trajectory and to move the second holder 16 in accordance with the second vector or trajectory. Preferably, only one trajectory is determined, since when moving the instrument 102, not only the target point is important, but also the path from an actual position to a desired position must be taken into account.In this way, it can happen that the surgical instrument 102 collides with parts of the patient's body, and for this reason a specific trajectory must be chosen to avoid a collision.

[0121] If a force-torque sensor unit 260 is provided, it is also connected to the control unit 280. The connection can be wired or wireless. The control unit 280 preferably has corresponding software in the storage unit 282, which is configured to process the signals provided by the force-torque sensor unit 260 and to control the drive 210 and / or a linear drive of the instrument holding device 120, or optionally the brake unit 220, accordingly. The force exerted by the surgical instrument 102 on the instrument holding device 120 can represent an operator request. For example, a surgeon may manually grasp the surgical instrument 102 and want to guide it to a specific point.In this case, forces F and moments M act on the instrument holder 120 from the surgical instrument 102, which are detected by the force-moment sensor unit. Corresponding signals are then provided to the control unit 280. The software means, preferably when executed on the processor 284, are configured to cause the control unit 280 to determine the movement, trajectory, or vector for the first and second linkage assemblies 110, 112 and / or a linear drive 238 of the instrument holder 120 in order to counteract the forces F and moments M acting on the instrument holder 120, and to provide control signals to the drive 210, the linear drive 238, and / or the braking device 220 in accordance with this movement, trajectory, or vector to execute the movement according to the trajectory or vector.This means that the surgical manipulator 100 responds to the operator's request and attempts to assume a pose that balances the forces F and moments M acting on the instrument receiving device 120.

[0122] Since such a procedure is not desired at all times, it is preferred that the surgical manipulator 100 has an integrated input system 300. The integrated input system 300 can, for example, include a microphone and / or a touchscreen to put the surgical manipulator device 100 into this mode by executing the described software. For example, it may be provided that the operator must enter a command such as "manual guidance mode" or "following mode," and this voice command is detected by the microphone, with corresponding signals being provided to the control unit 280. Control signals are provided by appropriate speech recognition software so that the software is executed on the processor 284.

[0123] Alternatively or additionally, a foot pedal 302 can be provided, which in this embodiment is coupled to the higher-level control unit 290. A corresponding signal S4 can be provided to the higher-level control unit 290 via the foot pedal 302, so that the higher-level control unit 290 forwards the corresponding signal S4 and makes it available to the control unit 280 of the manipulator device 100.

[0124] In a further embodiment, the surgical manipulator device 100 can communicate with a handheld mobile device 310. The mobile device 310 can be, for example, a tablet PC, a mobile phone, or another device designed as a remote control. Signals S5 can be wirelessly transmitted from the mobile device 310 to the control unit 280, which has a corresponding receiver for this purpose. The mobile device 310 can also be configured to display a representation of the pose of the manipulator device 100, for example, a simplified graphic representation of the pose. Software can be run on this mobile device that allows positioning of the surgical instrument by drag and drop, in particular via a touchscreen.If, for example, the patient is also depicted on the mobile device with specific landmarks, the surgical instrument can be automatically positioned via the mobile device 310 by selecting a particular landmark. The processing of the position request signals, which are sent to the control unit 280 as signal S5, is carried out in the manner described above.

[0125] Similarly, the integrated input system 300 can also have a display on which such representations are shown.

[0126] Of course, it is also possible to issue warning signals via the integrated input system 300 or the mobile device 310 if, for example, a predefined working space of the surgical manipulator device 100 is left, for example, if an operator in the manual positioning mode, as described above, manually positions the surgical instrument 102 and it is detected that it is being moved out of a predefined working space.

[0127] A push button 226 is arranged on the housing 104. The push button 226 has already been described above with reference to the braking device 220. The push button 226 can be configured depending on the design of the surgical manipulator device, i.e., whether a drive 210 or a braking device 220 is provided. If the braking device 220 is provided, the push button 226 is preferably parameterized as a release device 225, and the brakes 221, 222, 223, 224 can be released via the push button 226.

[0128] In the event that a drive 210 with motors 211, 212, 213, 214 is provided instead of the braking device 220, the push button 226 is preferably parameterized as a so-called home button 312. In this embodiment, pressing the push button 226, when parameterized as a home button 312, moves the surgical manipulator device to a predefined starting position stored in memory 282. In this way, it is possible to move to a predetermined and stored position by simply pressing the push button 226. Preferably, it is also provided that the stored position can be saved using the push button 226. For this purpose, the button 226 is held down for a predetermined period of time (for example, 3 seconds), and the current position is stored as a pre-stored position in the memory device 282, in order to be recalled and approached by pressing the button 226 again.

[0129] To initially read or define a pivot point for a surgical instrument 102, a pivot point gauge 320, which according to the present invention is designated as a surgical instrument 102, can be mounted on the first and second holders 114, 116. This is in Figure 23 The pivot point gauge 320 is shown more precisely on the instrument mounting device 120 and there by means of the second coupling element 262, which with reference to Figure 21 It was recorded and described in detail.

[0130] The pivot point gauge 320 has a shaft 322 and a tapered section 324. The tapered section is designed to be received between the clamping jaws 270, 269. The axial extent of the tapered section 324 corresponds to the axial length of the clamping jaws 269, 270 with respect to axis K4. This means that the pivot point gauge 320 has a defined position with respect to the coupling element 262 and thus also with respect to a coordinate system of the surgical manipulator device 100. The axial length of the pivot point gauge 320 is known, and therefore also the position of the probe head 324, which is formed at one axial end of the pivot point gauge 320. To read a pivot point PT, the operator now manually, or electrically controlled, guides the manipulator device 100 into a pose in which the probe head 324 is positioned at the patient-specific pivot point of the patient.

[0131] For this case, the control unit 280 preferably includes software means which, when executed on the processor 284, calculate the coordinates of the probe 324 and thus also of the pivot point PT based on the position of the individual joints and the pose of the first and second link assemblies 110, 112, as well as the position and orientation of the instrument mounting device 120. To save these pivot point coordinates and / or to provide them at the interface 106, an operator preferably makes a user input, for example, by pressing the button 226, which may be parameterized for this purpose. It may also be provided that a button or the like is provided on the pivot point gauge 320 itself to perform the saving and / or provision of the coordinates.

[0132] The control unit 280 is preferably further configured to calculate the pivot point when another surgical instrument 102, which does not have the same axial length as the shaft 322 of the pivot point gauge 320, is inserted, relative to this surgical instrument, and to move it axially along the longitudinal axis K4 accordingly. For example, if an endoscope is inserted (see Figure 102), the control unit 280 is preferably further configured to calculate the pivot point when another surgical instrument 102, which does not have the same axial length as the shaft 322 of the pivot point gauge 320, is inserted. Fig. 2 The axially lower tip of the endoscope may be positioned differently from the probe 324. If the geometry of the endoscope is known, the position of the pivot point can be transformed accordingly.

[0133] Figure 24 This illustrates once again the determination of the pivot point PT and the corresponding calculation. Figure 24 The surgical manipulator device 100 is shown schematically, while detail A is shown from the left side of the Figure 24The figure on the right shows a further enlarged view. In this embodiment, the surgical manipulator device 100 is mounted in a holding arm 1, as already shown with reference to Figure 1 The schematic representation of the manipulator device 100 is identical to the schematic representation of the manipulator device 100 from [reference missing]. Figure 24 Therefore, full reference is made to the above description. Identical and similar elements are also marked with the same reference symbols.

[0134] Initially, the support arm 1 is fixed to an operating table and has a coordinate system KS0, which is a base coordinate system. The patient is also located in the coordinate system KS0, since the patient's position generally does not change relative to the base 10 of the support arm 1 during an operation.

[0135] Using the described pivot point gauge 320, a tool center point coordinate system KS TCP can be determined, which lies at the first pivot point PT1. The pivot point PT1 is the pivot point that was determined using the pivot point gauge 320 via the probe head 324. The Z-axis of the coordinate system KS TCP points in the direction of the axis K4, which is defined by the instrument mounting device 120. The position of the axis K4 is parallel to the axis L1 of the linear drive and can be inclined (as in Fig. 22 ) to the first and second planes of motion B1, B2. The angle of attack γ The distance between the axis K4 and the first plane of motion B1 is defined by different actuation of the first and second linkage arrangements 110, 112.

[0136] When another surgical instrument 112 is inserted, the pivot point PT1 is initially located at the position recorded using the pivot point gauge 320. However, the pivot point PT1 can also be shifted along the longitudinal axis K4 by calculation. For example, the current pivot point shifts from pivot point PT1 to pivot point PT2 when the surgical instrument 102 is inserted into the patient's body. Thus, for instance, the endoscope, which is advanced during the procedure to visualize the surgical area, can always be shifted during so-called keyhole surgery so that the pivot point is located approximately in the area of ​​the keyhole. In individual cases, the pivot point may also lie outside the axis K4.

[0137] Preferably, a transformation matrix is ​​also determined between the basis 10, i.e., the basis coordinate system KS0, and one of the coordinate systems at the pivot point KS PVP, or the initial pivot point KS TCP. Preferably, this transformation matrix is ​​also provided via interface 106 and / or stored in memory 282.

[0138] The definition and storage of the pivot point PT1, PT2 can also be used for cyclical rotation of the surgical instrument 102. Such cyclical rotation is used, for example, by operators to gain a spatial impression of the field observed by an endoscope. In the case where an endoscope is used as the surgical instrument 102, the following method is preferred, which, with reference to Figure 25The following will be explained in more detail: (1.) The operator positions the endoscope; (2.) the operator initiates a pivoting movement or automatic start via the control unit 280 after positioning; (3.) the determination of support points 330a, 330b, 330c, 330d relative to the current pose for an endoscope tip 103, wherein the support points 330a, 330b, 330c, 330d together define a path 332. The path 332 can be planned, i.e., run continuously through the support points 330a, 330b, 330c, 330d. Alternatively, the support points 330a, 330b, 330c, 330d are approached directly and discretely. Preferably, the path 332 is elliptical. The elliptical path 332 is preferably determined by the control unit 280 using the support points 330a, 330b, 330c, 330d. The instrument 102 is then pivoted onto the path 332. A pivoting path 334 is required for this purpose.The instrument 102 is then preferably moved such that the tip 103 travels along the path 332 until a corresponding abort signal is received at or generated by the control unit 280. A swivel path 336 is then provided for swinging back to the initial position.

[0139] If the instrument 102 is moved along its longitudinal axis K4 in the Z direction with respect to the pivot point coordinate system KS PVP, the tip 103, for example, comes to a point which is in Figure 25 is designated 103'; thus, instrument 102 is shifted by a distance ΔZ. In this case, path 332 is transformed to path 332', which lies on the envelope cone 338 spanned between pivot point PT2 and path 332. Determining the transformed path 332' is preferably performed by the control unit 280 using suitable software.

[0140] The surgical manipulator device 100 preferably further comprises a display device 350 for indicating one or more states of the surgical manipulator device 100. The general function of such a display device is also described in EP 3 130 305 A1 with reference to joints of the holding arm disclosed and claimed therein, and this teaching can be applied analogously to the present manipulator device, in particular its joints.

[0141] The display device 350 can, in principle, be designed in any way, for example, comprising a display, or, in the embodiment shown in the figures, the display device comprises several display segments, namely firstly an upper display segment 352 ( Fig. 23 ) and a lower display segment ( Fig. 5). In this embodiment, the terms "top" and "bottom" refer to an initial position of the surgical manipulator device 100 in which the first and second planes of movement B1, B2 are essentially horizontally aligned, and the upper display segment 352 points upwards.

[0142] The upper and lower display segments 352, 354 are designed as ring-shaped light strips and are specifically composed of a plurality of LED elements. The two display segments 352, 354 are identical and mirror-symmetrical with respect to the first and second planes of motion B1, B2, respectively. This has the advantage that, regardless of the position of the surgical manipulator device 100, an operator can see either the upper display segment 352 or the lower display segment 354.

[0143] Furthermore, according to this embodiment, each of the upper and lower display segments 352, 354 has four individual segments 355, 356, 357, 358. The first display segment 355 is assigned to the first lever pivot point 121, the second display segment 356 to the second lever pivot point 122, the third display segment 357 to the third lever pivot point 123, and the fourth display segment 358 to the fourth lever pivot point 124. For example, it is provided that when one of the lever pivot points 121, 122, 123, 124 or the corresponding levers 131, 132, 133, 134 is moved, the correspondingly assigned segment 355, 356, 357, 358 is illuminated to indicate the actuation.Since two of the levers are linked together and cannot move independently, it is also possible for the first segment 355 to be assigned to the first motor, the fourth display segment 352 to the second motor, the second display segment 356 to the third motor, and the third display segment 358 to the fourth motor if a drive 210 is provided for the manipulator device 100. In this way, the four display segments 355, 356, 357, 358 are spatially assigned to the corresponding motors 211, 212, 213, 214 that are actuated. This allows the operator to see which of the motors 211, 212, 213, 214 is being actuated and in which direction the instrument, or the first and second holders 114, 116, or the surgical instrument 102 held therein, will move.

[0144] It can also be provided that, for assistance purposes, a luminous dot travels along the path of the annular upper or lower display segments to indicate the direction of movement of a lever 131 to 139. This is particularly preferred if the manipulator device 100 is designed as a passive manipulator device 100 and has a braking device 220. When the brakes 221, 222, 223, 224 are released, the luminous dot, which travels around or along a display segment 355, 356, 357, 358, can indicate a direction in which an operator must move the surgical instrument 102, for example, to bring it to a pivot point or into another predetermined pose.

[0145] Further display options have already been described above. In this context, "display" refers in particular to the switching of segments 352 and 354, partially or completely, from an illuminated state to an unilluminated state; the changing of a color, an intensity, a flashing frequency, or an intensity fluctuation frequency; and the display of one or more partially rotating luminous points with a higher or lower intensity or a different color.

[0146] In a further embodiment, the display device 350 may also have one or more infrared light sources via which it can communicate with a surgical navigation system. The infrared light is preferably connected in sync with the other LEDs and thus indicates the same state as the display device 350 as a whole. That is, the infrared light can be used to inform a surgical navigation system that, for example, a motor has been activated or that some other state of the manipulator device 100 has been changed.

[0147] It may also be intended that this infrared light is used to wirelessly transmit other data, such as pivot point coordinates or the like, to the operating room navigation system.

[0148] Even if in this embodiment ( Fig. 25As shown in Figure 1, segments 355, 356, 357, and 358 together form a ring. In other embodiments, each of these segments 355, 356, 357, and 358 may also be annular in itself and assigned to a lever pivot point 121 to 129. It may also be provided that the ring of the upper and lower display segments 352 and 354 is not closed or has a different geometry. Likewise, it is conceivable to provide further display devices or alternative display devices on the sides of the housing 104.

[0149] In Figure 25The interface 106 is also shown. This has a recess 360 in its center, which has a plurality of flanks for positive locking with a projection of a tripod, support arm, or the like. A pin 362 is provided to lock the positive locking connection. This pin engages in a corresponding recess on the projection of the support arm or tripod, thus locking the positive locking connection. This pin can be moved upwards with respect to 25 by pressing a push button 364. The push button 365 is held in place by a spring (see Figure 25). Fig. 16 , 17 ) pre-tensioned into the locked position.

[0150] Furthermore, the interface 106 has a plurality of electrical contacts, which in this embodiment are collectively designated 366. A collar 368 projects axially around the interface 106 and serves in particular to seal the interface from the environment. This prevents the electrical contacts 366 from coming into contact with liquid or the like.

Claims

1. A surgical manipulator device (100) for positioning a surgical instrument (102), in particular an endoscope, with a frame (108), a first mount (114) and a second mount (116) configured to mount the surgical instrument (102), in particular by means of an instrument receptacle (120) for the surgical instrument (102), a first suspension arm arrangement (110) mounted on the frame (108), to connect the first frame (108) to the first mount (114) in an articulated manner, and a second suspension arm arrangement (112) supported on the frame (108), and configured to connect the frame (108) to the second mount (116) in an articulated manner, wherein the first and the second suspension arm arrangements (110, 112) are spaced apart and each displaceable relative to the frame (108) in first and second motion planes (B1, B2) parallel to each other, such that the first mount (114) is displaceable in the first motion plane (B1) and the second mount (116) is displaceable in the second motion plane (B2), wherein the first suspension arm arrangement (110) is coupled to the frame (108) at four first lever pivot points (121, 122, 123, 124) of the first suspension arm arrangement (110) with the frame (108), and the second suspension arm arrangement (112) is coupled to the frame (108) at four lever pivot points (125, 126, 127, 128) of the second suspension arm arrangement (112) to the frame (108), wherein each respective lever pivot point (121, 122, 123, 124) of the first suspension arm arrangement (110) has a common axis of rotation (R1, R2, R3, R4) with a respective lever pivot point (125, 126, 127, 128) of the second suspension arm arrangement (112).

2. The surgical manipulator device according to claim 1, wherein the four first lever pivot points (121, 122, 123, 124) and the four second lever pivot points (125, 126, 127, 128) are each arranged in a V-shape.

3. The surgical manipulator device according to one of the preceding claims, wherein the four lever pivot points (121, 122, 123, 124) of the first suspension arm arrangement (110) and the four lever pivot points (125, 126, 127, 128) of the second suspension arm arrangement (112) are arranged on four common axes of rotation (R1, R2, R3, R4), or the four lever pivot points (121, 122, 123, 124) of the first suspension arm arrangement (110) and the four lever pivot points (125, 126, 127, 128) of the second suspension arm arrangement (112) are offset parallel to each other.

4. The surgical manipulator device according to one of the preceding claims, wherein the first suspension arm assembly (110) comprises: a first (131), a second (132), a third (133), and a fourth lever (134), each of which is rotatably mounted at first, second, third, and fourth lever pivot points (121, 122, 123, 124) of the first suspension arm assembly (110) on the frame (108); a first suspension arm (141) pivotally coupled to the first and second levers (131, 132) and a second suspension arm (142) pivotally coupled to the third and fourth levers (133, 134); and first and second rods (151, 152) that are rotatably coupled on one side to the first suspension arm (141) and on the other side to the first mount (114), as well as third and fourth rods (153, 154) that are rotatably coupled on one side to the second suspension arm (142) on one side and rotatably coupled to the first mount (114) on the other side.

5. The surgical manipulator device according to one of the preceding claims, wherein the first suspension arm arrangement (119) comprises a first (91), a second (92), a third (93), and a fourth parallelogram (94), wherein preferably the first and second parallelograms (91, 92) comprise a common pivot point (161), and / or the third and fourth parallelograms (93, 94) comprise a common pivot point (166).

6. The surgical manipulator device according to one of the preceding claims, comprising a drive (210) for the first and second suspension arm assemblies (110, 112), wherein the drive (210) comprises a first and a second motor (211, 212) for the first suspension arm assembly (110), and a third and fourth motor (213, 214) for the second suspension arm assembly (112).

7. The surgical manipulator device according to one of the preceding claims, comprising a braking device configured to (220) actively brake the first and second suspension arm arrangements (110, 112) and a releasing unit (225) configured to selectively release one or more degrees of freedom of the first and / or second suspension arm arrangments (110, 112), wherein the braking device (220) comprises a first and a second brake for the first suspension arm arrangement (221, 222) (110), and a third and a fourth brake (223, 224) for the second suspension arm arrangement (112).

8. The surgical manipulator device according to one of the preceding claims, comprising an instrument receiving device (120) coupled to the first and the second mount (114, 116) in an articulated manner, wherein the instrument receiving device (120) comprises form-fit means (258) set up for receiving a coupling element (262) for the surgical instrument (102), and wherein the coupling element (262) is formed from an insulating material in order to electrically insulate a surgical instrument (102), if received in the coupling element (262), relative to the instrument receiving device (120) and the first and second mounts (114, 116).

9. The surgical manipulator device according to claim 8, wherein the instrument receiving device (120) comprises a linear drive (230) for positioning the surgical instrument (102) at least partially perpendicular to the first and second motion planes (B1, B2).

10. The surgical manipulator device according to one of the preceding claims, comprising an electronic interface (106) for receiving control signals from a higher-level control unit (290), in particular an operating room navigation system or a surgical holding arm (1) with the higher-level control unit (290).

11. The surgical manipulator device according to one of the preceding claims, comprising a housing (104) with a display device (350) configured to display one or more states of the surgical manipulator device (100), wherein the display device (350) preferably has two, preferably four, display segments, each display segment being assigned to two or one of the four lever pivot points of the first and / or second suspension arm arrangement (110, 112).